Age_Woods c"`-.`-'"4. APPLICATION FOR SENIOR CITIZEN COUNTY TOWNSHIP YEAR'� �_ PROPERTY TAX BENEFITS
State Form 43708(R16/1-23) IL13DCJI
1overnment Finance FIL $.. L\
Information contained in this document is CONFIDENTIAL pursuant to IC 6-1.1- ,QY 1
INSTRUCTIONS: To be filed in person or by mail with the county a i r of the county whef411f4 p erty i ocated.
Filing Date: Form must be completed and signed by December a( h cou ty audit postmarked by the following
January 5 of the calendar year in which the property taxe are tile.
Ty4,, J 00
See reverse side for additional instructions and qualifications. TOF. .41:. \ 1""�1 (°co `-
Type of Benefit Requested(Please check all t apply)
t
ver 65 Deduction
Owned with Joint Tenant or Tenant in Common,Indicate with Whom
es E No
If Name on Record is Different than Applicant,Indicate Below Do All Joint Tenants or Tenants in Common Reside on the Property?
Lid'Yes ❑ No
Name of Contract Seller Has Applicant Owned or Bought the Property Under Recorded Contract for at Least
\{` 111/�[\_ One(1)Year before Claiming Deduction? ❑ Yes ❑ No
Address of Contract Seller(number and street,city,state,and ZIP code) Is the Property in Question:
Y Real Property ❑ Mobile Home(IC 6-1.1-7)
Taxing District Key Number/Legal Description Record Number Page Number
L).- \(\\ 1-,k) - U — Q — I—. Cc, per. sci-73-01s'.
Does Applicant Resid on Property? Assessed value of the property as of current year assessment date(May not exceed$240,000 for Over 65 Deduction or
$199,999(counting just the homestead site)for the Over 65 Circuit Breaker Credit received before January 1,2020,and$199,999(al
IVY'es ❑ No Indiana real property)for the Over 65 Circuit Breaker Credit initially applied for after December 31,2019.)See reverse for details.
Is the Applicant 65 Year of Age or More on December 31 of the Year Prior
$
Have You Filed for Any Other Deductions? If Yes,Wh Deductions?
es ❑No •,Iv'k •
Have You Filed for Deduction in Any Other County?ty If Yes,What County?
ID Yes EJ No
I/We certify under penalty of perjury that the above and foregoing information is true and correct.
Signature of 47f
� Date(month,day.year)
- u Ill
Address of Applicant(number an treet,city,state,and ZIP code)
CD\_ ' \ . x 100 tom, e-1Q 2\e 4 n ��-1 L '4
Signature of Authorized Representative Date(month,day,year)
Address of Authorized Representative(number and street,city,state,and ZIP code)
Si nature of County Auditor Date(month,day,year)
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DISTRIBUTION: Original—County Auditor; File-Stamped Copy—Taxpayer